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Graded Motor Imagery in Carpal Tunnel Syndrome

30 augustus 2026 bijgewerkt door: Zeynep Yıldız Kızkın, Artvin Coruh University

Is There an Advantage to Incorporating a Central Nervous System-targeted Intervention Within an Exercise Program for Individuals Diagnosed With Carpal Tunnel Syndrome? A Randomized Controlled Trial

The aim of this study is to investigate whether the addition of Graded Motor Imagery (GMI) to progressive neurodynamic exercises is more effective than progressive neurodynamic exercises alone in individuals with carpal tunnel syndrome (CTS). The objectives are to reduce pain and symptom severity, improve pain, sensorimotor function, physical performance, and grip strength through the addition of GMI.

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

46 voluntary patients with CTS, aged between 30-60 years will be randomly divided into two groups: GMI and progressive neurodynamic exercise group. Interventions will be applied for 6 weeks, 2 times a week (12 sessions). Both groups will receive progressive neurodynamic exercises and a nighttime resting splint. The GMI group will additionally receive Graded Motor Imagery, while the control group will receive no additional intervention. The patients will be assessed before, and after treatment. Upper extremity function and disability will be assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, cognitive status will be screened using the Mini-Mental State Examination (MMSE), and symptom severity and functional status related to CTS will be evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Sensory function will be assessed using the Semmes-Weinstein Monofilament Test and the Two-Point Discrimination Test, fine manual dexterity will be evaluated using the Purdue Pegboard Test, and hand grip strength will be measured using a Jamar hand dynamometer.

Studietype

Ingrijpend

Inschrijving (Geschat)

46

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen

Accepteert gezonde vrijwilligers

Nee

Beschrijving

Inclusion Criteria:

  • mild to moderate unilateral CTS based on the Bland classification of electrodiagnostic testing ;
  • positive Phalen or Tinel tests;
  • symptoms such as paresthesia and pain associated with CTS that last longer than 3 months;
  • patients aged 30-60 years (when CTS becomes more prevalent);
  • patients who achieved a minimum score of 24 on the Mini-Mental State Examination (MMSE).

Exclusion Criteria:

  • bilateral CTS;
  • history of prior CTS surgery;
  • clinical indicators of cervical radiculopathy or polyneuropathy;
  • pregnancy or cognitive impairment;
  • the presence of orthopedic, neurological, or functional problems on the unaffected side that could affect hand function (e.g., history of trauma or surgery, peripheral nerve injury, tendinopathy, tenosynovitis, trigger finger, arthritis, sequelae of a fracture, etc.);
  • receipt of any conservative treatment for CTS within the last month.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Enkel

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Graded Motor Imagery
Each patient in the Graded Motor Imagery group will receive a treatment protocol consisting of Graded Motor Imagery, progressive neurodynamic exercises, and nighttime resting splints.
Ander: Graded Motor Imagery (GMI)

GMI includes three stages. GMI program will span over 6 weeks. The first 2 weeks will focus on lateralization, followed by 2 weeks of motor imagery, and the final 2 weeks will involve mirror therapy.

Lateralization: Patients will be asked to differentiate whether the hands shown in the Recognise™ Hand application belongs to the right or left side of their body.

Motor Imagery: Patients will be instructed to imagine slowly and smoothly moving their affected extremities to the posture depicted in the photos in the Recognise™ Hand application and then returning to the starting position.

Mirror Therapy: Using a mirror measuring 300 x 300 x 300 mm³ placed between the upper extremities, patients will be instructed to progressively move only their unaffected extremity, then their affected extremity, and finally both extremities.

Ander: Progressive Neurodynamic Exercise
The progressive neurodynamic exercises involved holding each position for 5 seconds. Each session included two sets of 10 repetitions (2×10). The treatment lasted for 30-minute sessions, conducted twice weekly over a total of 6 weeks.
Ander: Nighttime Resting Splint
The night splint was fitted with a wrist splint that keeps the wrist in a neutral position, permits finger flexion, maintains the wrist within a 0°-5° extension range, and ends just distal to the distal palmar crease.
Actieve vergelijker: Progressive Neurodynamic Exercises
Each patient in the progressive neurodynamic exercises group will receive a treatment protocol consisting of progressive neurodynamic exercises and nighttime resting splints.
Ander: Progressive Neurodynamic Exercise
The progressive neurodynamic exercises involved holding each position for 5 seconds. Each session included two sets of 10 repetitions (2×10). The treatment lasted for 30-minute sessions, conducted twice weekly over a total of 6 weeks.
Ander: Nighttime Resting Splint
The night splint was fitted with a wrist splint that keeps the wrist in a neutral position, permits finger flexion, maintains the wrist within a 0°-5° extension range, and ends just distal to the distal palmar crease.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Disabilities of the Arm, Shoulder, and Hand (DASH)
Tijdsspanne: Baseline
DASH is a 30-item self-report tool assessing upper-extremity disability and symptoms, including daily activities, pain, numbness, joint stiffness, weakness, sleep issues, and psychological effects. Examples include turning a doorknob, changing a light bulb, and cutting food. Scores range from 0 to 100; higher scores indicate more severe symptoms and impairment.
Baseline
Disabilities of the Arm, Shoulder, and Hand (DASH)
Tijdsspanne: After the 6-week intervention
DASH is a 30-item self-report tool assessing upper-extremity disability and symptoms, including daily activities, pain, numbness, joint stiffness, weakness, sleep issues, and psychological effects. Examples include turning a doorknob, changing a light bulb, and cutting food. Scores range from 0 to 100; higher scores indicate more severe symptoms and impairment.
After the 6-week intervention

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Mini Mental State Examen
Tijdsspanne: Basislijn
Het Mini-Mental State Examination (MMSE) zal worden gebruikt om de cognitieve status van patiënten te beoordelen. Het bestaat uit 11 vragen en wordt beoordeeld op een schaal van 30 punten. Een score tussen 24-30 wordt als normaal beschouwd, 18-23 duidt op milde cognitieve stoornissen en een score van 17 of lager duidt op ernstige dementie. De MMSE beoordeelt oriëntatie, geheugen, aandacht, berekening, herinnering, taal, motorische functie, perceptie en visueel-ruimtelijke vaardigheden.
Basislijn
Mini Mental State Examination
Tijdsspanne: After the 6-week intervention
The Mini-Mental State Examination (MMSE) will be used to assess the cognitive status of patients. It consists of 11 questions and is evaluated on a scale of 30 points. A score between 24-30 is considered normal, 18-23 indicates mild cognitive impairment, and a score of 17 or below is indicative of severe dementia. The MMSE assesses orientation, memory, attention, calculation, recall, language, motor function, perception, and visuospatial abilities.
After the 6-week intervention
Boston Carpal Tunnel Syndrome Questionnaire (BCTQ)
Tijdsspanne: Baseline
A patient-reported assessment uses a 5-point Likert scale with two subscales: the 11-item Symptom Severity Scale (CTSQ-S) for symptom intensity like numbness and pain, and the 8-item Functional Status Scale (CTSQ-F) for ADL ability such as writing and dressing. Higher scores mean more severe symptoms and impairment. The BCTQ shows high reliability, validity, and sensitivity to clinical changes.
Baseline
Boston Carpal Tunnel Syndrome Questionnaire (BCTQ)
Tijdsspanne: After the 6-week intervention
A patient-reported assessment uses a 5-point Likert scale with two subscales: the 11-item Symptom Severity Scale (CTSQ-S) for symptom intensity like numbness and pain, and the 8-item Functional Status Scale (CTSQ-F) for ADL ability such as writing and dressing. Higher scores mean more severe symptoms and impairment. The BCTQ shows high reliability, validity, and sensitivity to clinical changes.
After the 6-week intervention
The Semmes-Weinstein Monofilament Test
Tijdsspanne: Baseline
The assessment used a monofilament test (0.49-0.96), known for high sensitivity in diagnosing CTS. Sensory thresholds were checked at the radial tips of the thumbs, index, middle, and ring fingers. The monofilament was applied perpendicularly to the dorsal finger pads with eyes closed and the wrist in a neutral position. Pressure was applied for 1 to 1.5 seconds until slight bending of the filament. Lower readings indicate better sensory function; higher readings suggest worse light touch perception. A gauge of 2.83 grams is the normal threshold, while 3.22 grams or higher indicates moderate-to-severe sensory impairment in CTS.
Baseline
The Semmes-Weinstein Monofilament Test
Tijdsspanne: After the 6-week intervention
The assessment used a monofilament test (0.49-0.96), known for high sensitivity in diagnosing CTS. Sensory thresholds were checked at the radial tips of the thumbs, index, middle, and ring fingers. The monofilament was applied perpendicularly to the dorsal finger pads with eyes closed and the wrist in a neutral position. Pressure was applied for 1 to 1.5 seconds until slight bending of the filament. Lower readings indicate better sensory function; higher readings suggest worse light touch perception. A gauge of 2.83 grams is the normal threshold, while 3.22 grams or higher indicates moderate-to-severe sensory impairment in CTS.
After the 6-week intervention
Purdue Pegboard Test
Tijdsspanne: Baseline
The Purdue Pegboard consists of 50 holes in two columns, with pins, washers, and sleeves in four recesses at the top. Patients sat in front of the apparatus and performed four tests: the dominant hand, non-dominant hand, two-hand, and assembly test. For the hand tests, they inserted pins into holes with their hands for 30 seconds each; the two-hand test used both hands. In the assembly test, they placed materials in order: pin → washer → collars → washer within 60 seconds. Each test was repeated three times, and scores were averaged. This test assesses fine motor skills, coordination, finger dexterity, hand-eye coordination, and small object manipulation; lower scores indicate poorer hand skills.
Baseline
Purdue Pegboard Test
Tijdsspanne: After the 6-week intervention
The Purdue Pegboard consists of 50 holes in two columns, with pins, washers, and sleeves in four recesses at the top. Patients sat in front of the apparatus and performed four tests: the dominant hand, non-dominant hand, two-hand, and assembly test. For the hand tests, they inserted pins into holes with their hands for 30 seconds each; the two-hand test used both hands. In the assembly test, they placed materials in order: pin → washer → collars → washer within 60 seconds. Each test was repeated three times, and scores were averaged. This test assesses fine motor skills, coordination, finger dexterity, hand-eye coordination, and small object manipulation; lower scores indicate poorer hand skills.
After the 6-week intervention
The Two-Point Discrimination Test
Tijdsspanne: Baseline
The two-point discrimination threshold was evaluated using an esthesiometer applied to the pulp of the thumb, index, and middle fingers. During the evaluation, participants' eyes remained closed, and light stimuli, consisting of either one or two points, were randomly presented along the longitudinal axis of the fingers. The procedure began at a distance of 5 mm, with 10 trials conducted at each specified interval. If the participant failed to achieve at least seven correct responses, the distance was increased by 1 mm, and the test was repeated. The discrimination threshold was defined as the smallest distance at which at least seven out of ten responses were correct. Testing was discontinued at a maximum distance of 15 mm, with values below 6 mm considered within normal limits.
Baseline
The Two-Point Discrimination Test
Tijdsspanne: After the 6-week intervention
The two-point discrimination threshold was evaluated using an esthesiometer applied to the pulp of the thumb, index, and middle fingers. During the evaluation, participants' eyes remained closed, and light stimuli, consisting of either one or two points, were randomly presented along the longitudinal axis of the fingers. The procedure began at a distance of 5 mm, with 10 trials conducted at each specified interval. If the participant failed to achieve at least seven correct responses, the distance was increased by 1 mm, and the test was repeated. The discrimination threshold was defined as the smallest distance at which at least seven out of ten responses were correct. Testing was discontinued at a maximum distance of 15 mm, with values below 6 mm considered within normal limits.
After the 6-week intervention
Grip Strength
Tijdsspanne: Baseline
Grip strength was measured using a hand dynamometer. The participant sat comfortably with shoulder abducted, elbow at 90°, and forearm neutral. The wrist was between 0° and 30° extension. Each hand was tested three times with one-minute rests, and the average was recorded.
Baseline
Grip Strength
Tijdsspanne: After the 6-week intervention
Grip strength was measured using a hand dynamometer. The participant sat comfortably with shoulder abducted, elbow at 90°, and forearm neutral. The wrist was between 0° and 30° extension. Each hand was tested three times with one-minute rests, and the average was recorded.
After the 6-week intervention

Medewerkers en onderzoekers

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Sponsor

Artvin Coruh University

Onderzoekers

  • Hoofdonderzoeker: Zeynep Yıldız Kızkın, Artvin Coruh University

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

1 maart 2027

Primaire voltooiing (Geschat)

1 juli 2027

Studie voltooiing (Geschat)

30 december 2027

Studieregistratiedata

Eerst ingediend

30 augustus 2026

Eerst ingediend dat voldeed aan de QC-criteria

30 augustus 2026

Eerst geplaatst (Werkelijk)

2 september 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

2 september 2026

Laatste update ingediend die voldeed aan QC-criteria

30 augustus 2026

Laatst geverifieerd

1 augustus 2026

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • Graded Motor Imagery in CTS

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Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

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Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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